Health professionals are rallying around in support of the French government's plan to make 11 vaccines compulsory for children. Prof. Philippe Sansonetti, a microbiologist and infectious disease specialist at the Institut Pasteur, signed the petition launched by the French Society of Pediatricians, together with more than 1,300 colleagues* and infancy specialists. He reminds us that vaccines are effective against potentially severe, often contagious diseases. He believes that the dangerously insufficient levels of vaccination coverage in France justify making some vaccinations compulsory. But he emphasizes that this measure should be backed up by a major information campaign.
*As of July 6, 2017, 1,593 health professionals had already signed the petition calling for extended vaccination coverage.
Prof. Sansonetti, why did you sign this petition in favor of compulsory vaccination?
Speaking personally, I would really prefer it if vaccinations did not have to be compulsory. Extending compulsory vaccination for children could be a temporary measure, as recommended by the large-scale public consultation on vaccination. Once we have raised awareness and given people sufficient information, we may be able to remove the obligation for compulsory vaccination. We'll have to see what happens, but the state of public health at the moment is very worrying. There is no doubt as to the benefit of vaccination for diphtheria, tetanus and polio, as well as for whooping cough, rubella and hepatitis B, and also pneumococcal infections and meningitis.
So maintaining the idea that some vaccines are "compulsory" and some are "recommended" no longer makes sense and merely leads to a lack of understanding among the public and to difficulties for doctors in explaining the facts. It can be very confusing, and I can understand why parents might start raising questions. But the 11 infant vaccinations are vital in medical terms.
Do you think we need to redouble our efforts to explain why vaccines are so important?
Absolutely. Compulsory vaccination only makes sense if it is backed up by efforts to inform citizens and train up medical staff. When you realize that in some hospitals and retirement homes, only 20% of care workers are vaccinated against influenza, it raises questions about whether they are setting the right example – it's understandable that people are starting to have doubts.
It's important to be vaccinated to protect yourself personally, of course, but above all it's about protecting others, especially those who are vulnerable: children, the elderly (who represent an increasing proportion of the French population), pregnant women, and immunodeficient people receiving cancer treatment, for example, who cannot be vaccinated for medical reasons. That's why I wouldn't say I'm especially "pro-vaccine" but I'm definitely "pro-children's health"! And collective protection also boosts our chances of eliminating some infectious diseases.
So by protecting the most vulnerable members of our communities, we can avoid the devastating impact of infectious diseases?
Yes – but it's also worth simply remembering the advantages of vaccination! We tend to have very short memories – not so long ago, when our great-grandparents were alive, in 1900, 150 children out of every 1,000 died before reaching their first birthday. Today that figure stands at just 3 out of every 1,000. Bringing in compulsory vaccination for the 11 infant vaccines will enable us to create a "protective bubble" around young children. And to be perfectly honest, 11 vaccines is not many when you look at the number of diseases children are potentially exposed to.
Is vaccination also a way of avoiding the problems associated with antibiotic resistance?
We can't be sure of that, because antibiotic resistance is caused by a whole host of different factors. But it's clear that vaccination reduces the frequency of bacterial infections and superinfections and therefore reduces bacterial exposure to antibiotics. Vaccination is certainly one weapon in the fight against antibiotic resistance, at a time when the diminishing efficacy of antibiotics is a real cause for concern.
You mentioned the rise in measles cases. How can vaccination be useful against that disease, for example?
Sufficient vaccine coverage will enable us to contain outbreaks so that children do not have to face the risk of severe complications that can require them to spend time in intensive care. In 2006-2007, barely 40 cases of measles were reported in France. But from 1 January 2008 to 31 December 2016, the number of cases reported in the country stood at more than 24,000. Of these cases – and here I'm quoting the official figures from Santé publique France – nearly 1,500 led to severe respiratory complications requiring intensive care, 34 led to encephalitis and 10 proved fatal. Three of the ten patients who died were too young to be vaccinated and seven were immunodeficient. With 95% vaccination coverage, we could protect the weakest individuals from measles.
There is a lot of contradictory information about vaccines. What message should we give to parents who are worried about vaccination?
We mustn't let our views be swayed as soon as a new claim about vaccination emerges. With many of us now getting our information from the internet, we need to pay attention to where this information comes from and be very cautious of messages on private blogs that can easily spread via social media. In the late 1990s, a rumor took hold about a completely non-existent link between the measles vaccine and autism. The scientific community has since debunked this false claim, but the rumor is still circulating to this day. Similarly, for more than 90 years, aluminum has been used in tiny doses, lower than the quantities babies and children are exposed to in their environment (from breast milk, drinking water or food). It has never been proven to be toxic over the long term. This demonization is creating a backlash against vaccines.
How can we know what to believe?
I would advise parents to trust their doctor. The petition I have just signed comes from health professionals who work with small children, experts who know what they are talking about, treat children regularly and have extensive knowledge of medicine and biology. And I would add that we are also citizens, parents and grandparents ourselves. The controversy over vaccination represents a danger for our children, and by signing this petition we want to protect the youngest members of society. What we are calling for is a measure that will offer clarity, and it will lead to peace of mind if we really step up our efforts to provide information and training.
I would also mention that the debate about vaccination is a first-world problem. In Africa and Asia, the question of whether vaccines are useful does not even come up, because in those regions there is a terrible shortage of vaccines.
Vaccination in France
Just three infant vaccines (diphtheria, tetanus and polio) are currently compulsory in France, and eight others, including whooping cough, hepatitis B and measles, are only recommended. On July 4, 2017, the French government announced that compulsory vaccination would be extended to include the 11 infant vaccines, to help overcome the low coverage of some vaccines and fight against the reemergence of diseases such as measles.